HomeMy WebLinkAbout12-08-10BUREAU OF INDIVIDUAL TAXES
PO DOX 280601
HARRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE TAX
ccI, FORMATION NOTICE
.~> r "' -' ~a~~~~L ~~ AND FILE N0. 21 'rp 12.6 ~
.:~ +'Jr ~~~! ..TAXPAYER RESPONSE ACN 10165762
DATE 11-16-2010
REY-15<3 E% 11FP (0E-CR)
' l.] e
CLERK OF t
o~p~v~s cc ° ,,T
SHUGHART BARBARA
16 RAYLEN DRIVE
SOILING SPRINGS PA 1y007
EST. OF GRETTA A OTT
SSN 175-34-8390
DATE OF DEATH 11-04-201 Q!
COUNTY CUMBERLAND,
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF
MEMBERS 1ST FCU provided the Department with the infonation below, which has been ~sed in calculatins
potential tax due. Records indicate that at the death of the above-named decedent, you were a Joint owner/b nafigiary of this
If you feel the information is incorrect, please obtain written correction from the financial institution, a~ta h,a copy to thi
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of he C6mmonwealth of
Pennsylvania. Please call C717) 787-8327 with questions.
COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INS R TIONS
Account No. 204708-00
Account Balance
Percent Taxable
Awount Subject to Tax
Tax Rate
Potential Tax Due
Data 05-03-2001
Established
g 310.45
X 50.000
$ 155.23
X .045
$ 6.99
ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
the
'count.
form
To ensure proper cre at to the account, two
copies of this notic~ ^ st accompany
payment to the Regis~er of Wills. Make cheek
payable to "Register, of Wills, Ag•nt".
NOTE: If tax payunts ire made within hree
months of the deeede~t'k date of death,
deduct a 5 percent dp'sc~uht on the tax ue.
Argr Inheritance Tax pue will become de inquen
nine months after the d~ta of death.
P~T TAXPAYER RESPONSE
1
A. The above infonation and tax due is correct.
LLLLLLJJJJJJ Remit payment to the Register of Wills with two copies of this notice to!obi~sin
CHECK a discount or avoid interest, or check box "A" and return this notice to h Register of
C ONE ~ Wills and an official assessment will be issued by the PA Department of ikev~nua.
BLOCK B. ~ The above asset has bean or will be reported and tax paid with the Pennsylva~ia'Inheritance Tax return
ONLY to be filed by the estate representative.
C. ~ The above infor^a eon is incorrect and/or debts and deductions were paid.
Complete PART ~2 and/or PART ~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
.._ .-_
LINE 1. Data Established 1
2. Account Balance 2 ~
3. Percent Taxable 3 X
4. Awount Subject to Tax 4 ~
5. Debts and Deductions 5 -
6. Amount Taxable 6 ~
7. Tax Rate 7 X
8. Tax Due 8 ~
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION ! AMOU T PAID
TOTAL (Enter on Line 5 of Tax Cowputation) i ~~ t
Under penalties of perjury, I declare that the facts I have reported abnov/e~are t
cowplete to the/blest /of~wy kn/owle~dpe- and belief. HOME C / ~/ ) !?
r'YJi!'~IA.iJ>/.1. /1/•i.~w/Lrs /_ WORK C )
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